Nationwide, more than one in four patients refuse their referrals to home health.¹ This is a dangerous and costly game. Consider this. A large study has shown that, despite being generally younger and healthier, people who refuse their home health referral have a 25% higher mortality rate and cause $15,000 more in healthcare spending over the next year. Why would people refuse home health when original Medicare routinely pays 100% with no deductible or copay? An expert round table suggested that people refuse home health because they think their risk is low and they can manage on their own just as well. Repeatedly, this turns out to be not as true as many people suspect. Adding to this evidence, in February, the American Journal of Managed Care published a first-of-its-kind study showing that even in low-risk scenarios, people who get home health have better outcomes.

Short-Hospital Stays Signify Lower Risk

Multiple large studies have shown that people who refuse home health end up costing more, spending more time in the hospital due to readmissions, and having a higher likelihood of death.^2,5,6 What is different about the current study is that it focuses on discharge after hospital stays that are shorter than average. A short hospital stay implies a less serious condition, perhaps one where home health would not change the outcome. For instance, in the current study by Patrick Racsa et al., only 7% of patients were readmitted to the hospital within 30 days. Compare this to other studies covering all hospital discharges where the 30-day readmission rate ranged between 17% and 30%.  

Home Health After Short Hospital Stays

The researchers analyzed more than 19,000 Medicare Advantage, short-stay, hospital discharges from more than 8,000 hospitals nationwide. Roughly 4,000 received home health while about 15,000 did not. Those patients who received home health had 60% lower 30-day-readmission risk. Over the three months following hospital discharge, their healthcare spending was 11% less. That adds up to more than a $2,000 savings per patient. Risk of mortality was low among these patients (0.6%), but home health cut that risk 66% in raw numbers. 

Conclusion

People who qualify for home health should ask for home health. It will likely improve outcomes and save money – and possibly save lives.

References

1. Trella Health. Industry Trend Report 2020. Available online: https://2k5mvxeyf44ix5rc3b9wsy11-wpengine.netdna-ssl.com/wp-content/uploads/2021/02/Trella-Industry-Trend-Report-2020_REV2.pdf
2. Xiao R, Miller J, Zafirau W, et al. Impact of home health care on health care resource utilization following hospital discharge: a cohort study. The American Journal of Medicine. 2018; 131 (4): 395-407.
3. Levine C, Lee T. “I can take care of myself!” Patients’ refusals of Home Health Care Services. A report from a Roundtable Sponsored by United Hospital Fund and the Alliance for Home Health Quality Innovation. 2017 May; ii – 19.
4. Racsa P, Rogstad T, Stice B, Flagg M, Dailey C, Li Y, Sallee B, Worley K, Sharma A, Annand D. Value-based care through postacute home health under CMS PACT regulations. The American Journal of Managed Care. 2022 Feb 1;28(2):e49-54.
5. Quality Insights. New Jersey Home Health Readmission Report. US Dept Health Human Services. 2016; Pub QI-C3-112015.
6. Topaz M, Kang Y, Holland D, et al. Higher 30-day and 60-day readmission among patients who refuse post-acute care services. American Journal of Managed Care. 2015; 21 (5): 414-433.